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Chapter 9: Tales from the COVID-19 front lines

“Cash-strapped, underemployed and unemployed pet owners will desperately seek deals and discounts if unemployment persists more than another few weeks.”

Chapter 9: Tales from the COVID-19 front lines
Homeless pets are harder to find as people staying at home can dedicate more time to raising a cat or dog.
This week: The veterinary industry is in a state of flux as some stay-at-home restrictions are eased, pets are adopted in record numbers, and team members return to work or choose not to. The next few weeks could answer a lot of questions. Read other installments in this series: Chapter 1  Chapter 2  Chapter 3  Chapter 4  Chapter 5  Chapter 6   Chapter 7  Chapter 8  Chapter 10  Chapter 11  Chapter 12  Chapter 13  Chapter 14  Chapter 15
North Carolina veterinarian, speaker, consultant and Today’s Veterinary Business editorial adviser Ernie Ward, DVM, CVFT Every veterinary clinic I spoke with last week reported higher than expected appointments and revenues. This was in stark contrast to U.S. Department of Labor reports that 14.7% of American workers were not working at all. What does this economic dichotomy mean for veterinary professionals during the upcoming months? 1. Fluctuating demand for veterinary services. In-clinic veterinary visits will likely see an increase in the next few weeks as pent-up demand peaks. Once this initial wave of visits subsides, expect to see a gradual slowdown in the third quarter. If a second, severe U.S. outbreak of COVID-19 occurs in the fall, I think the rest of 2020 will be in economic jeopardy and then continue until we have a fully deployed vaccine. If we don’t experience a significant second coronavirus wave and a vaccine remains on schedule for the first quarter of 2021, I believe we’ll begin to experience real economic recovery during the first half of 2021. 2. Increased price pressure. Cash-strapped, underemployed and unemployed pet owners will desperately seek deals and discounts if unemployment persists more than another few weeks. Annual visits, immunizations and preventives might take a hit as families are forced to choose between food and heartworm medication. Manufacturer rebates and discounts will likely be needed to keep these pet owners administering basic endo- and ectoparasite preventives over the next several months. It’s hard to make up these financial losses. American families will have to make spending cuts somewhere, with discretionary expenses such as dining out, vacations and preventive pet care some of the first to go. Overall, I think we should expect to see general practice veterinary revenues down at least 10% in 2020. I’d consider that a huge economic win for the veterinary profession. 3. Waves of good and bad economic times. Those of us in the veterinary and pet industries need to be prepared for waves of good and bad economic times over the next two years, with various sectors disproportionately affected. The early winners will be online sales and services, and the losers will be legacy business models based solely on in-person transactions and overpriced offerings. 4. A shift to online and direct to consumer. I predict a continued shift toward online purchasing of all pet supplies, including pharmaceuticals and food. This means in-clinic and in-store sales will suffer. Expect more companies to further decrease their reliance on selling through the traditional veterinary clinic channel. Over the next six months, we’ll begin seeing more pharmaceutical and food companies offer their products directly to consumers or through strategic acquisitions or alliances with online retailers. How long can Zoetis, Boehringer Ingelheim, Merck or Mars delay partnering, acquiring or starting an online direct-to-consumer channel? I think the market will soon force them to be more aggressive in these growth opportunities as consumer demand expands. 5. Emergency and specialty care stay strong. ER visits will likely increase as pet owners delay preventive care and lose contact with general practitioners. Specialty clinics will thrive because higher-income earners, many shielded from pandemic economic impacts, will continue to be able to afford their services. 6. Other considerations. I think pet insurance will be an essential element of future general veterinary medicine success. Also, the coming direct-to-pet-owner, in-home diagnostic test boom will compel veterinarians to shift how we interact with clients and could catalyze in-clinic diagnostic growth if we message and frame it correctly. We will have unimaginable opportunities to innovate and grow during the next couple of years. Times of resource scarcity serve as the best pressure cookers to create amazing new recipes for success. Stay safe and take this chance to reinvent how you practice veterinary medicine.
Veterinary industry consultant Karen E. Felsted, DVM, CPA, MS, CVPM, CVA Veterinary medicine is in a bit of a bubble now, isolated from some of the harsher aspects of the pandemic. Of course, we’ve been impacted — revenue is down in some practices, some hospitals have closed, conferences have been canceled, colleagues and their friends and family members have gotten sick or died, team members have been furloughed or laid off, and we’ve had to change how we operate. However, the effect on us is much lighter than on other professions and industries such as dentists and restaurants. That is small comfort for our colleagues and friends who have been significantly impacted but is true for the profession as a whole. My concern is whether it will last. Unemployment is at almost 15% and unemployment benefits will run out. The Paycheck Protection Program money lasts only two months. All the pent-up demand for pet care because pet owners are home and paying attention will diminish as the pets get treated. And we’re entering a recession of unknown magnitude. Many states are starting to reopen. Is that going to be a good or bad thing? The uncertainty is a killer, but it’s smart to continue to be concerned about the future. That means offering superior value to clients, reducing operating expenses, limiting major expenditures, deferring loan and rent payments if needed and possible, and conserving cash in case the situation gets worse. And speaking of the future, we will get through this. It’s going to be interesting to see which of the changes we’re making now will stick. Will telemedicine be more firmly entrenched? Will home delivery of food and medications occur more frequently? Will we go back to hugging people after a euthanasia? Will it be easier to find employees? What will corporate groups be willing to pay for practices? Will practices be more financially conservative? All of these are unknown at this point and certainly will depend on the magnitude of the economic impact. But they are worth thinking about and planning for.
Creative Disruption columnist and WellHaven Pet Health chief medical officer Bob Lester, DVM I’ve long advocated for three big changes to our veterinary world. Two of the three have taken giant steps forward as the coronavirus crisis forces rapid and profound disruption on our profession. One sadly, has languished. What have we learned? What can we still learn? 1. Crisis benefit: Embracing technology in support of the veterinary team and pet parent connection. I’m confident that we’ve done more texting, blogging, chatting, emailing, Zooming, social media posting, website updating and telemedicine consulting than ever before. That’s a big win for pets, clients and veterinary professionals. Society, state boards (except California), pet families and our profession have a new appreciation for the role of technology in quality practice. Let’s hang on to technology gains in support of better pet health and client connections post-COVID. Millennials in particular appreciate it. How might this even be done better? What other opportunities exist? 2. Crisis benefit: Recognition of the importance of preventive care. Society and our profession have rediscovered the importance of preventive care as an officially designated essential service. We remained open for the critical role we play in both two-legged and four-legged health. Record numbers of new pet placements meant a greater need for essential preventive care. As pets and families sheltered in place, we’ve been reminded of the importance of immunizations, parasite care, zoonotic disease prevention, dental health, behavior and proper nutrition. Governors’ offices, state boards, veterinary professionals and pet families have gained a deeper understanding of the importance of prevention. The value of pets in families has never been higher. Ironically, by safeguarding the wellness of our nation’s pets, we’re also safeguarding the well-being of our profession. A side effect of proactive preventive care is a decrease in reactive, stressful and often unfunded emergent care and declines in stress, burnout, compassion fatigue and worse among our colleagues. Let’s never lose sight of the importance of preventive care. How might preventive care be delivered even more effectively? 3. Crisis squandered: Veterinary technician/nurse utilization. Perhaps it’s just me, but over the term of the pandemic I’ve not seen our profession embrace the power of the veterinary nurse. Unlike what we’ve seen with technology and preventive care, the role of the veterinary nurse has not been elevated. I see it on the human nurse side. That is not to say that veterinary nurses didn’t step up. They did. As usual, they provided the energy, compassion, intellect and drive to help us through the crisis. But they could have been allowed to do so much more. Veterinary nurse appointments, veterinary nurse teleconsults, rabies vaccinations, microchips, skin and gingival suturing, catheter placements, simple extractions — the list goes on. The state boards I follow didn’t further empower veterinary nurses to perform additional procedures, veterinarians didn’t utilize our nurses to the top of their license, and society didn’t benefit from the amazing skills these underappreciated member of our health care team are more than capable of providing. Why is that? I wish I knew. We’ve squandered an opportunity to further elevate the importance of the veterinary nurse. But, ever the optimist, I say it’s not too late. Throughout the remainder of this pandemic and beyond, let’s work harder to empower, utilize and honor these vital veterinary health care partners. How might nurses be further empowered using technology and improving preventive care? Let’s not let a crisis go to waste. Honor your veterinary nurses. Always seek ways through people and technology to improve the delivery of veterinary care. Together we’ll emerge from COVID-19 stronger than ever.
Veterinary industry consultant Debbie Boone, CVPM Last week brought some very good news. Many practices are reporting that business is up. I saw figures mostly around 20% but one as high as 50% over year to date. Puppy and kitten visits are leading the way as more stay-at-home clients determine that they have the time to housebreak and train their new pet. They also long for the comfort pets bring in uncertain time, so they are purchasing and adopting at amazing rates. Some shelters report empty cages. Behaviorists in particular are concerned that we will see a rash of separation anxiety from pets as their owners return to work. They are offering tips that can help prepare animals for changes to their routine. Practice managers and owners who received Paycheck Protection Program loans are wondering if the windfall was all it was cracked up to be. They are keeping separate records for PPP’s utilization but are determining how to keep the payroll at pre-COVID rates when many staff members are on unemployment and are not willing to return to work and lose the extra money they are receiving. Since unemployment comes with a $600 boost, the staff members are taking home more than when they were working. Coming back is a hard sell for managers who need staff and need to spend the PPP funds. Most practices are keeping new protocols in place for at least a few more weeks. Many mention June 1 as the day they might allow clients to go inside their hospitals. Also, inventory managers are struggling with shortages and skyrocketing prices for common products. As they search for alternate suppliers, 503B compounders are stepping up to help fill the voids.
Today’s Veterinary Nurse editor-in-chief and NAVC director of veterinary nursing Kara Burns, MS, MEd, LVT, VTS (Nutrition) Veterinary nurses are finding that changes instituted during the COVID-19 pandemic are becoming routine. Curbside protocols along with history taking and discharge instructions via telephone have become standard. The majority of hospital teams to which I have spoken have personnel wear masks all day long in the hospital and continue to focus on protocols designed to keep pet owners and colleagues safe. I am seeing and hearing that veterinary hospitals remain busy. The influx of pets being adopted by families under stay-at-home mandates has resulted in new pet and essential vaccination visits, as well as an increase in veterinary teams providing care and direction to these new pet owners via telephone. Additionally, some governors have begun to ease restrictions and even allow elective procedures in certain states. Although this is relatively new, I am seeing and hearing that owners are still leery and, at least preliminarily, are taking a wait-and-see approach. Regardless, the majority of hospitals are going with the flow and remain busy, but their protocols have changed. They anticipate continuing this standard of care for quite some time. If and when things change, veterinary teams will roll with that change. Although some veterinary hospitals needed to cut hours, the majority report being as busy and in some cases busier then pre-pandemic. For me, one of the signs that COVID-19 has not decimated the veterinary profession is the number of places hiring all kinds of team members. The positivity of veterinary teams during these unprecedented times is both surprising and not surprising. Working through the COVID-19 pandemic is unnerving and terrifying, but the fact that veterinary teams go to work and help people and their pets every day regardless of what is happening around them is not surprising to those of us in veterinary medicine. Veterinary teams may be concerned for their own health, but what I am seeing is veterinary nurses asking each other about dealing with the specifics of the new normal, such as sharing protocols, communications strategies and where to get CE on specific topics. Remaining positive and ensuring that pets are cared for and that the team and pet owners stay safe and healthy is what I am seeing in our incredible profession.
Beyond Indigo Pets president and Today’s Veterinary Business editorial adviser Kelly Baltzell, MA Life is about adjustments. Some changes that veterinary practices have made are improvements over pre-COVID systems. For example, one of my clients began using online forms to gather information before the pet arrives at the hospital. They gathered so much information this way and streamlined the intake system that they plan to keep the process intact. In April, they had almost 700 form submissions. Another silver lining is the cost of Facebook pay-per-click (PPC) advertising and the fantastic results being produced. Facebook uses an auction system for advertising, which means lower ad costs when demand is less. Plus, people at home are flocking to Facebook for something to do. Here are some results we saw in April from clients requesting a reach/brand ad:
  • Hospital 1: Spent $40 and yielded over 27,000 impressions over two weeks.
  • Hospital 2: A two-week, $30 campaign yielded 20,656 impressions and 22 link clicks.
I have seen strong results from ads promoting online shopping.
  • Hospital 1: $30 for a two-week online store ad yielded over 7,000 impressions and 66 link clicks. Those results were fantastic, particularly for a short Rx ad in rural Vermont.
  • Hospital 2: An online store ad yielded 9,619 impressions and 66 link clicks. That was a two-week, $40 campaign.
  • Hospital 3: A March prescription-refill ad yielded over 8,000 impressions and generated 60 link clicks, which is higher than I normally see.
If your hospital hasn’t focused on Facebook ads, now might be a great time to dip into the water. Last week on Beyond Indigo’s Facebook Live page, Dr. Amanda Landis-Hanna talked about online charities and how veterinary services are doing on the West Coast, photographer Dani Werner discussed the importance of having a great head shot when you’re thinking about a career change, and Alexander Peterson of Wagly Veterinary Hospital and Pet Campus was my guest in the “View From the Hospital” series. Check out the three videos and others at bit.ly/3fIMblQ.
Veterinary nurse and National Association of Veterinary Technicians in America President Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM) I would like to highlight three things. First, I had the privilege of being part of a discussion regarding financial-assistance programs for members of our profession, many of whom have been affected by furloughs, reduced hours or an inability to work due to COVID-19. Looking at what could be done to provide more immediate relief for them was uplifting to me. Veterinary technicians and nurses are obviously looked upon as vital members of the veterinary team, and finding ways to support them is going to be important. I look forward to the results of the discussions, and I hope that members of our profession are helped and feel supported by the entire field. Second, the spread of the pandemic made students of veterinary and veterinary technology/nursing programs move the last few months of the school year to virtual platforms. This cut short the time that graduating classes traditionally spend kindling memories, expressing gratitude, sharing nervousness and celebrating their next career steps. Unable to hold in-person commencement ceremonies, some schools went the virtual route. Dr. Andy Roark’s team stepped up to the plate, too, hosting the College of Veterinary Medicine Virtual Graduation on May 3 — replay it at bit.ly/VirtualGraduation — and scheduling the Veterinary Technician and Nurse Virtual Graduation for May 24. (Learn more at bit.ly/NurseGraduation.) Third, we saw the swift and generous efforts of veterinary professionals in offering medical equipment such as mechanical ventilators to human health care to help meet the demands. While it sometimes took patient explanation for human health care professionals to realize that we use the same equipment but on different species, many pieces of equipment were drafted into the battle against COVID-19. One ventilator donated by NorthStar Vets was returned to the practice along with a heartfelt letter of gratitude indicating that “This ventilator was critical life-sustaining equipment for five of the 100 adult ventilator patients in our critical care unit.” Four of the patients were extubated and survived. Seeing the ways in which veterinary medicine and human medicine came together, exemplifying the fact that we are all in this together, is inspiring.
San Diego veterinarian, author and speaker Jessica Vogelsang, DVM, CVJ As stay-at-home restrictions start to lift and clinics begin looking to the future, many of them are wondering if the telemedicine they adopted in the interim is a stopgap or a real long-term solution. The answer depends on how successful the clinic was in integrating the communication tool into the workflow. Most of the clinics in the Veterinary Telemedicine Community Facebook group love what telemedicine has done for them and have no intention of leaving it all behind. The possibilities are just too useful. As an example, many clinics are using live video streaming to communicate with the client in real time, while curbside drop-offs are the norm. As social distancing eases and clients come back into exam rooms, that specific need will go away, but the clinics will continue to use the video idea for other drop-off appointments or follow-up exams. Clinics that are using two-way messaging to triage suddenly realize that the tool reduces the phone burden on customer service representatives and the amount of time doctors spend on the phone answering “quick questions” from the client. The real beauty in telemedicine tools has less to do with the physical distancing and everything to do with convenience and efficiency. That need isn't going away. Here in California, the California Veterinary Medical Board has agreed to hold a special meeting Thursday to address its view on telemedicine and the veterinarian-client-patient relationship. The board has indicated a continued concern with veterinarians mismanaging remote means of communication and potentially misdiagnosing pets that should have gone to the clinic. Whether or not we are successful in changing the board members’ minds, we have enough people using telemedicine to know that the overall response from veterinarians and clients is overwhelmingly positive. There’s no ambiguity here. Whether a state chooses to be on the cutting edge of change or play catch-up, telemedicine is here to stay.
Getting Technical columnist, practice management consultant and Patterson Veterinary University instructor Sandy Walsh, RVT, CVPM Curbside is still the norm for most veterinary clinics, but things are evolving and practices are busy. Many are starting to plan for allowing clients back inside the practice. With the weather warming, we need to start thinking of different ways to safely accommodate clients that don’t involve sitting in a hot car in the parking lot or in a crowded waiting room, with or without their pets. We want to protect employees and also keep clients safe and comfortable. I have seen so many creative ways to provide protection. Many clinics have plexiglass shields at the reception desk. Some have added plexiglass dividers or clear shower curtains in the exam rooms so that clients can be in the room. We have always been a creative group, now more than ever. Practice teams are taking a look at inside traffic flow and making plans to accomplish physical distancing. These include:
  • Floor pawprints six feet apart for waiting clients.
  • The reorganization of waiting room seating when more than one client is present.
  • Staggered scheduling.
  • Immediately sending clients into exam rooms.
  • Taking payments in the exam room.
  • Mandating face covers for clients and staff members.
  • Enhanced cleaning and sanitation protocols.
  • Daily employee health screenings.
As more and more stay-at-home restrictions are lifted, practices will see the client volume increase further. Wellness is happening again, furloughed employees are coming back and many practices are hiring. Also, Paycheck Protection Program loans are still trickling in to relieve some of the financial worries of practice owners. I’m seeing more optimism than pessimism. It’s a good change.
Veterinary industry consultant and Southern California Veterinary Medical Association executive director Peter Weinstein, DVM, MBA Practices in Southern California that honored the mandate of providing only essential services are peeking their heads out like a groundhog. How many more weeks of winter will they have to endure before they see the light of spring? However, people are talking about life after lockdown. From my conversations, I found that it’s business as usual on the outside and planning for the next normal on the inside. What physical changes are needed in the building? What level of personal protective equipment will need to be maintained? Will clients be let in the building and in what numbers? Will curbside morph with inside for a Labradoodle-like hybrid practice? And, in the employee-friendly state of California (from a legal HR standpoint), practices are trying to figure out who to bring back, how to bring them back and what if they don’t want to come back. Practices remain busy at all different levels but are still routinely below the same period last year. The busy-ness is from the inefficiencies caused by the client and patient delivery model.  The busy-ness is from not having fully perfected the systems needed to not have to think about every little detail for completing a visit. Interestingly, in looking at regional numbers, the numbers of transactions are down significantly more than the revenue amounts. This probably reflects the need to defer wellness visits and focus on sickness, which routinely has a higher average transaction. So, per-visit earns are better with fewer turns. Whose head is above water? Those practices with strong leadership, focus, vision and communication skills. They have been able to keep their teams together and head in a common direction. They have been able to offer a level of certainty during a significantly uncertain period. Speaking subjectively, I get the feeling that mental health is starting to wear. Clients are getting snippier, staff members are more sensitive, and leadership is concerned about the immediate and distant future. The light at the end of the tunnel, at least here in California, still feels like a train is approaching. And compound that anxious feeling with recently great weather but no place to go and nothing to do. People are starting to lose their patience (and maybe their patients). We need people to share what they are doing to keep morale up, the staff happy, the clients happy and mental health healthy. I’m working on my COVID-19 set list of music to get me through the crisis. What’s on yours?
White House, Tennessee, hospital managing partner Whit Cothern, DVM Last week was the first week of our plan to return to normal. The objective is a return to pre-COVID business operations via a gradual increase in capacity in May while continuing to protect the safety of our team via curbside service and personal protective equipment. We restarted elective procedures although we are still limited due to some PPE supply constraints like sterile gloves. Pre-COVID, we typically had three veterinarians working every business day, but over the last few weeks the number was only one or two. Last week, we had two or three each day, and we likely will operate at that level for the foreseeable future. The last few weeks generated revenue numbers similar to 2018 levels. While this result was mostly self-induced, I’ve shared with our team that it would not be prudent to just flip a switch and return to 2020 spending levels. It is critical that we see not only the level of demand return but also the willingness and ability of pet owners to spend at pre-COVID levels. My doctors shared that they are seeing a dichotomy of pet owners. On one hand, some had not sought veterinary care in years but now seem willing to make up for the lapse. On the other hand are pet owners who always followed our recommendations but are now either unemployed or underemployed. So, how did last week turn out? Despite the number of invoices still being down versus the same week in 2019, our revenue was up a small amount, the first positive uptick since mid-March. Was it the start of a trend or because of pent-up demand? Should we accelerate our return to normal based on one week? And what will “normal” be when and if we finally get beyond COVID-19? Just a few more to add to the list of questions unimaginable only 60 days ago.
Crum & Forster Pet Insurance Group assistant vice president of veterinary relations Wendy Hauser, DVM This past week, the Veterinary Hospital Managers Association hosted an intriguing webinar. While the content was insightful and practical, the robust chat from participants was even more interesting as it captured the challenges of managing practices in the third month of COVID-19. The word I would use to sum up the emotions in the chats is “overwhelmed.” Reflecting on the experience, I found three takeaways: 1. Hospital leadership needs personal connections to help navigate the challenges. Despite the many excellent resources available on dedicated veterinary websites, in webinars and through the VHMA, leaders need a more tangible connection to other leaders. During the webinar, they attempted to establish such a connection through the real-time chat feature. Now is the time to reach out to colleagues in your area and brainstorm how to work together to safely provide veterinary resources to your communities. If you don’t have an established network in place, look for commonalities: Which neighboring hospitals share your values, like Fear Free, Cat Friendly or American Animal Hospital Association accreditation? You can also reach out to your state VMA for help in building a cohort. 2. Don’t overanalyze. A friend in an unrelated industry shared that high-level leaders were spending six hours a week trying to figure out the best course for managing the return from a work-from-home policy. My advice to him was that great resources are available to help his company chart a way back. Veterinary hospitals should consult local resources, the American Veterinary Medical Association’s COVID-19 website and the Centers for Disease Control and Prevention to gain perspectives. The situation is fluid; continue to talk with your teams at least weekly about what is going well and what can be better, then take action to fine-tune your actions. 3. Take the first step. It is human nature to procrastinate when one is overwhelmed. In the present, everything feels like an urgent need. We tend to tackle more comfortable challenges, delaying action on projects that will position our hospitals for success in the next 12 to 24 months. To make headway on critical projects, break them into smaller pieces. Commit to tackling a weekly step in the project, perhaps completing a component or spending a set number of uninterrupted hours on it. By making incremental headway, you are empowered to continue progress toward completing your goal.
We want to hear from you: How has the COVID-19 emergency affected you, your practice or your veterinary business? Email editor Ken Niedziela at [email protected].
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